Book review: Doing Clinical Ethics

By Daniel Sokol, barrister and senior lecturer in medical ethics at Imperial College London (Springer 2012)

Reviewed by Dr June Tay, junior doctor in anaesthetics, London

Doing Clinical Ethics is a concise and comprehensive book, which is easy to read. The author, Daniel Sokol, beautifully captures the theoretical essence of medical ethics and applies it to real life. He divides his book into five chapters, encompassing ethical theory and case-based discussions, teaching, writing papers and research in the ethical context.

Chapter 1 provides a step-by-step guide to approaching a clinical scenario. Sokol summarises the sections into moral perception, moral reasoning and moral action. Within moral reasoning, he outlines the four principles: respect for autonomy, beneficence, non-maleficence and justice.

He also introduces the “four quadrants approach”, which can be applied to every clinical case. These are medical indications, patient preferences, quality of life and contextual features. An example provided was the case of a 22-year-old woman, BMI 51, with a history of self harm, who set herself alight moments after discharge from the emergency department, and as a result had to be admitted to intensive care and a specialist burns unit. Tattooed on her chest was the following: DNAR (underlined) DO NOT RESUSCITATE . He clearly analyses the ethical issues employing the “four quadrants approach”, which makes for really interesting reading.

What I gained the most from the book is encompassed in the next chapter, which covers writing and publishing a paper. Sokol draws most of the examples on writing an ethics paper; however, these are universally applicable to other topics and articles. The elements addressed and the examples given resonate well with the challenges faced by clinicians – authorship, rejections and abstract submissions.

Most of this insightful advice is not obtainable from textbooks, but only discovered through an individual’s experiences and struggles. Nevertheless, these issues are applicable to a junior doctor’s clinical career.

Not to be missed is the chapter on delivering teaching. Sokol elaborates on the various aspects of teaching junior doctors, medical students and other clinicians, with particular attention to teaching ethics. However, it is advice that one could employ to improve their teaching skills in general. Perhaps this chapter would benefit from further elaboration in a book on teaching skills.

The final chapter consists of appendices using pertinent examples of ethical issues that clinicians may encounter. Sokol provides a few cases and discusses the ethical principles involved. Among the two that I found most pertinent to my role as a junior doctor are “The Slipperiness of Futility” and “The Dilemma of Authorship”. It is perhaps the most engaging chapter in the book as real-life examples are employed, which most clinicians can identify closely with.

Overall, Doing Clinical Ethics is concise and uses simple language devoid of jargon. It particularly appeals to one who does not have the patience to dwell on lengthy prose. Perhaps some may feel that there is a lack of philosophical discussion of moral dilemmas, such as euthanasia and physician-assisted suicide. Others may feel that the aspects on teaching and writing ethics are too general and not particularly suited for a book entitled Doing Clinical Ethics. Nevertheless, it is a good read for anyone interested in medical ethics.

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